Orvosi hetilap最新文献

In hemoglobinopathies, hemoglobin A1c measurement may be distorted, making accurate monitoring of diabetes difficult. In addition to clinically apparent forms, "silent" hemoglobin variants also occur; these do not affect the blood count and may remain undetectable with routine methods such as high-performance liquid chromatography or hemoglobin electrophoresis. We examined blood samples from two patients using high-performance liquid chromatography and a chemical immunoturbidimetric method for hemoglobin A1c, as well as hemoglobin electrophoresis and beta-globin gene sequencing. In both cases, repeated oral glucose tolerance testing consistently excluded diabetes mellitus. In the first patient, hemoglobin A1c measured by liquid chromatography was not evaluable because of an abnormal chromatogram, necessitating an alternative method. In the second patient, the high hemoglobin A1c value obtained by the chromatography method contradicted the clinical findings. After consultation between clinicians and the laboratory, electrophoresis and chemical hemoglobin A1c measurement were performed; neither case showed abnormal fractions via electrophoresis. In the first patient, the chemical method produced a measurable but unusually low hemoglobin A1c value. Genetic testing identified the hemoglobin Graz mutation, known to cause falsely high or undetectable hemoglobin A1c by chromatography and falsely low values by immunoassay, without clinical symptoms. In the second patient, the chemically measured hemoglobin A1c was lower yet remained in the prediabetic range; genetic analysis identified the hemoglobin Rainier variant, associated with erythrocytosis and likely responsible for falsely elevated hemoglobin A1c by both measurement techniques. These hemoglobin variants have not previously been described in Hungarian publications. These cases highlight the importance of alternative A1c measurement techniques, genetic testing and additional glucose metabolism markers such as fructosamine, as well as close cooperation between clinicians and laboratories. Orv Hetil. 2026; 167(5): 196-203.

Introduction: During tooth extractions, there is always a possibility of complications. In the case of maxillary teeth, this can be oroantral communication. Its surgical management is important to prevent long-term complications. There are factors which can predict the possibility of oroantral communication, even with the help of a preoperative panoramic radiograph.

Objective: In our questionnaire-based study, we wanted to determine what aspects dentists take into consideration before tooth extractions, during referral to a specialist, and in complication management.

Method: Our Google Forms-based questionnaire was forwarded to the e-mail addresses of publicly funded clinics, as well as to private practitioners through social media platforms. The responses were evaluated using statistical methods.

Results: Experienced dentists preferred specialist referrals in cases of self-predicted sinus opening. The age group under 40 years significantly more often had specialist qualification than those over 40. Panoramic radiographs are often used during decision-making. Imaging is performed more frequently in the private sector than in the social funded care. Dentists practicing in the capital and Pest County take X-ray images more often than their colleagues working in other counties. With increased professional experience, the frequency of pre-extraction X-ray imaging decreased.

Discussion: Currently, there are no guidelines in Hungary for imaging procedures and complication prediction before tooth extractions. Predicting oroantral communication would be useful for both patients and dentists.

Conclusion: The popularity of preoperative panoramic imaging in diagnostics may justify the development of a panoramic X-ray-based recommendation. Orv Hetil. 2026; 167(4): 148-155.

Self-destructive behavior is a complex biological, psychological, and sociological process. Science has been able to understand this in detail. Thanks to the scientific applicability of artificial intelligence, we can learn about and map the deeper connections and layers of self-destructive behavior. At the same time, with the exponentially increasing, everyday use of artificial intelligence, statistically more and more people in need of mental help are using this technology, often instead of the help of helping professionals. The aim of this paper is to present this problem area in an interdisciplinary way. Orv Hetil. 2026; 167(4): 131-136.

Hand-foot-mouth disease is typically a mild, self-limiting enterovirus infection, most often caused by Coxsackievirus A16 and enterovirus A71. Over the past 15 years, however, Coxsackievirus A6 (CVA6) has emerged worldwide, including in Hungary, as the main pathogen responsible for atypical clinical forms. Atypical hand-foot-mouth disease differs from the classic presentation by widespread vesiculobullous and often painful skin eruptions, frequent perioral lesions and post-infectious nail changes. We present the case of a 2-year-old girl with generalized vesicobullous eruptions, in whom CVA6 (clade D3a) infection was confirmed by RT-PCR and Sanger sequencing methods. After initial resolution, a recurrence of skin lesions occurred, followed six weeks later by nail shedding, which healed without sequelae. Diagnosis relies on the knowledge of the atypical clinical presentation, molecular-based detection, most reliably performed from vesicle fluid, stool, or oropharyngeal samples. Recognizing atypical clinical form of hand-foot-mouth disease is crucial, as its clinical manifestations may mimic other vesiculobullous diseases, potentially leading to unnecessary therapeutic interventions. Orv Hetil. 2026; 167(4): 156-161.

Introduction: Major depressive and bipolar disorder cause deterioration in the quality of life for patients and, due to their prevalence, result in serious financial losses at the societal level. To our knowledge, the number of patients treated for these disorders in the state-funded Hungarian healthcare system (the so-called "administrative prevalence") has not yet been examined at the level of the entire population. As a result, no study has yet been conducted to determine how the administrative prevalence compares to the true prevalence established in previous epidemiological studies using standardized questionnaires and population samples (i.e., the so-called "epidemiological prevalence").

Objective: Estimating the 12-month administrative prevalence values for major depressive disorder and bipolar disorder.

Method: Using data from the National Affective Disorders Register - sourced from the National Health Insurance Fund (NEAK) - and two sets of criteria (namely, "permissive" and "restrictive" protocols) to determine the number of individuals identified on the basis of their appearance in the publicly funded healthcare system and/or the dispensing of subsidized medicines used to treat major depressive disorder/bipolar disorder in 2024, and then calculating the administrative prevalence rates.

Results: Using the "permissive" and "restrictive" protocols, we found the one-year administrative prevalences of major depressive disorder to be 2.12% (male: 1.26%; female: 2.90%) and 1.70% (male: 0.98%; female: 2.35%), respectively. For bipolar disorder, the same figures were 0.71% (male: 0.55%; female: 0.85%) and 0.60% (male: 0.46%; female: 0.73%).

Discussion: Based on data from NEAK, we determined the 12-month administrative prevalence values for major depressive disorder and bipolar disorder. Comparing these with the annual epidemiological prevalences of the two disorders, it is clear that both conditions are underdiagnosed and/or undertreated in Hungary.

Conclusion: Only about a quarter of patients with severe mood disorders appear in the publicly funded healthcare system. Our study has several limitations that may reduce the accuracy of our administrative prevalence estimates. Orv Hetil. 2026; 167(4): 137-147.

Reactive oxygen species, including oxygen-derived free radicals, play a key roles in all four phases of wound healing. During hemostasis, they participate in platelet activation, and simultaneously with the injury, their prompt release via NOX enzymes from the damaged cell membranes activates polymorphonuclear leukocytes. This continues during the inflammatory phase and also triggers the differentiation of monocytes into macrophages. During the granulation-proliferation process, they induce angiogenesis, and then in the maturation-remodeling phase, they are active in regulating endoproteases and maintaining collagen balance. Their excessive production can cause cell damage, prolonged inflammation, and disorders in chronic wound healing. Topical (local) and systemic antioxidant or anti-inflammatory therapies used at any stage of wound treatment play a crucial role in promoting wound healing, minimizing scar formation, and enhancing patient comfort. The effectiveness of various local therapies, such as silicone-based gel preparations, herbal creams, hyaluronic acid gels, and products derived from regenerative medicine, has been the subject of numerous international studies. This study aimed to evaluate the clinical effects of the most commonly used treatments and active ingredients - e.g., H2O2, povidone-iodine, vitamins C and E, alkaloids, polyphenols (flavonoids), phytomodulators, N-acetylcysteine, honey, silver, etc. - with particular regard to wound healing time, frequency of inflammatory reactions and the aesthetic appearance of scars. Based on a systematic review of international literature, it can be concluded that during the hemostasis phase of wound healing, the presence of low concentrations of endogenous hydrogen peroxide or the diluted form of the exogenous solution, while preparations containing natural antioxidants, have anti-inflammatory and skin-nourishing effects during the inflammation-proliferation phase. During the late phase of wound healing, specifically the maturation-remodeling phase, silicone-based treatments consistently show better results in reducing scarring. The analysis highlights that the personalized use of antioxidant and anti-inflammatory topical active ingredient therapies tailored to the specific phases of wound healing is key to achieving optimal postoperative results following surgery. Orv Hetil. 2026; 167(3): 109-118.

Mycotoxins are secondary metabolites produced by fungi that pose a serious threat to food and feed safety worldwide. Compounds synthesized by the fungal genera Aspergillus, Fusarium, Alternaria and Penicillium are well known to have adverse effects on plant development, human and animal health. Mycotoxins threaten ecosystem stability and reduce biodiversity. Many mycotoxins disrupt redox homeostasis in animal and human organisms. This redox imbalance is the cause of both acute toxicity and long-term severe poisoning and death. Warming increases mycotoxin production. An interdisciplinary approach to mycotoxicology is crucial for addressing this complex challenge. There is a need to develop effective detoxification strategies and quality control. Advanced biomonitoring techniques that track markers of oxidative stress can improve exposure assessment. Sustainable agriculture cannot be imagined without comprehensive mycotoxin risk management. Orv Hetil. 2026; 167(3): 80-87.